Healthcare Provider Details

I. General information

NPI: 1366981961
Provider Name (Legal Business Name): MRS. SHAVON MEYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONVERSE ST STE L3
LONGMEADOW MA
01106-1760
US

IV. Provider business mailing address

1100 OVERLOOK DR STE 230
PALMER MA
01069-9316
US

V. Phone/Fax

Practice location:
  • Phone: 413-544-1737
  • Fax:
Mailing address:
  • Phone: 413-544-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number008583
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01165300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11512
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: